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DATE: <br /> Fee: <br /> Ck#: <br /> TOWN OF SPRINGFIELD <br /> DRIVEWAY PERMIT <br /> Name & Address of Applicant: Driveway Location: <br /> c �✓ v l f G / Road Name: H cutely*-cr / cr f"` <br /> 33 • ' A Si- <br /> 41,4 t j/ r 3 Si (N/S/E/W) side <br /> Phone: ./Z;.`.1r 1— C'(16 .P.14 C1 <br /> Feet (N/S/E/W) of(nearest intersecting road) <br /> e1 <br /> Al rI - i / J1 '/ fn." <br /> 7 i:W .2 /� <br /> C Section: Lot # <br /> Subdivision <br /> CONDITIONS <br /> For access from private property to a town road the permitted driveway must meet all <br /> requirements per Town Ordinances 4.18. The applicant shall complete the Driveway Permit <br /> Checklist. <br /> By signing below, the applicant agrees to abide by the Town Ordinance and any other <br /> requirements imposed by Dane County and/or the State of Wisconsin. <br /> Applicant's Signature: ) r '"- Date: <br /> Permit Granted By: Date: <br /> (Town of Springfield Designee) <br /> (White copy—Town,Yellow—Applicant, Pink—Dane County Zoning) <br />